Introduction

 The goal of asepsis and aseptic practice in the operating room is to prevent the
contamination of open surgical wounds.
 The nurses’ surgical team accomplishes this by creating and maintaining the sterile
field and by following aseptic principles aimed at preventing microorganisms from
contaminating the surgical wound.

Principles

STERILE PERSONS – WHEN GOWNED AND GLOVED:

 Keep hands at waist level and in sight at all times.
 Keep hands away from the face.
 Never fold hands under arms.
 Gowns are considered sterile in front from the waist to shoulder level and the
sleeves from above the elbow cuffs
 Sit only if sitting for entire procedure.
 Articles dropped below waist level are discarded.

STERILE PERSONS – KEEP WELL WITHIN THE STERILE AREA AND FOLLOW THESE RULES
WHEN PASSING:
 Face to face or back to back.
 Turn back to non-sterile person or when passing.
 Face a sterile area when passing the area.
 Step back, away from the sterile field to sneeze or cough.
 Stand back at a safe distance from the operating table when draping the
patient.

NON-STERILE PERSONS IN OBSERVING A CASE, STAY INSIDE THE ROOM UNTIL THE CASE IS
COMPLETED. DO NOT WANDER FROM ROOM TO ROOM AS TRAFFIC IN THE OPERATING
ROOM SHOULD BE KEPT AT A MINIMUM. PATIENT PRIVACY SHOULD BE RESPECTED.

TABLES ARE STERILE ONLY AT TABLE LEVEL:

 Anything over the edge is considered unsterile, such as a suture or the table
drape.
 Use a non-perforating device to secure tubing and cords to prevent them from
sliding to the floor.

STERILE DRAPES ARE USED TO CREATE A STERILE FIELD:

 Only scrubbed personnel should handle sterile drapes.
 The drapes should be held higher than the OR bed.
 Patient is draped from the prepped incisional site out to the periphery.

STERILE PERSONS TOUCH ONLY STERILE ITEMS OR AREAS; UNSTERILE PERSONS TOUCH
ONLY UNSTERILE ITEMS OR AREAS:
 Sterile team members maintain contact with sterile field with worn gloves and
gowns.
 Supplies are brought to sterile team members by the circulator, who opens
wrappers of sterile packages. The circulator ensures a sterile transfer to the sterile
field.
 Only sterile touch sterile surfaces
 Principles

UNSTERILE PERSONS AVOID REACHING OVER STERILE FIELD; STERILE PERSONS AVOID
LEANING OVER UNSTERILE AREA:
 Scrub person sets basins to be filled at edge of table to fill them.
 Circulator pours with lip only over basin edge.
 Scrub person drapes an unsterile table toward self first to avoid leaning over
an unsterile area. Cuff drapes over gloved hands.
 Scrub person stands back from the unsterile table when draping it to avoid
leaning over an unsterile area.

EDGES OF ANYTHING THAT ENCLOSES STERILE CONTENTS ARE CONSIDERED UNSTERILE:

 When opening sterile packages, open package away from you first. Secure
flaps so edges do not dangle.
 The wrapper is considered sterile to within one inch of the wrapper.
 In peel-open packages, the edges where glued, are not considered sterile.

STERILE FIELD IS CREATED AS CLOSE AS POSSIBLE TO TIME OF USE:

 Covering sterile tables is not recommended.
 Sterile areas are continuously kept in view:
 Sterility cannot be ensured without direct observation. An unguarded sterile field
should be considered contaminated.

STERILE PERSONS KEEP WELL WITHIN STERILE AREA:

 Sterile persons pass each other back to back or front to front.
 Sterile person faces a sterile area to pass it.
 Sterile persons stay within the sterile field. They do not walk around or go
outside the room.
 Movement is kept to a minimum to avoid contamination of sterile items or
persons.

UNSTERILE PERSONS AVOID STERILE AREAS:

 Unsterile persons maintain distance of at least 1 foot from the sterile field.
 Unsterile persons face and observe sterile area when passing it to be sure
they do not touch it.
 Unsterile persons never walk between two sterile fields.
 Circulator restricts to a minimum all activity near the sterile field.

DESTRUCTION OF INTEGRITY OF MICROBIAL BARRIERS RESULTS IN CONTAMINATION:

 Strike through is the soaking through of barrier from sterile to non-sterile or vice
versa.
 Sterility is event related.
 Microorganisms must be kept to irreducible minimum:
 Perfect asepsis is an idea. All microorganisms cannot be eliminated. Skin cannot be
sterilized. Air is contaminated by droplets.